The California Senate Standing Committee on Appropriations recently passed several bills sponsored by Health Access California aimed at providing consumers with more information about health care costs as well as their rights as patients. The three bills are:

  • SB 908, which requires insurance companies to notify policyholders if the premium for a plan they choose is found “unreasonable” or    “unjustified” and that such consumers be given an open enrollment period to find another plan.
  • SB 1010, which adds detailed, publicly available information on prescription drug costs to existing health plan rate review. It also provides notice of increases in prescription drug costs to health plans and state purchasers.
  • SB 1135, which requires health plans and insurers to notify consumers and health care providers about patients’ right to timely care and language assistance.


According to a recent NEJM Catalyst article, the 2012 Massachusetts payment reform law is already having an impact on health care costs across the state. The article’s author, David Cutler, points to many factors that are contributing to a reduction in the growth of health care costs. The key driver was the establishment of an annual “cost growth benchmark” for the health care industry. Other factors included reduced price increases, declining hospital readmission rates, the increased use of high-cost case management programs, an increased use of alternative payment methodologies, closer review of proposed provider affiliations and acquisitions, and the launch of the state health information exchange.

In other news, MassHealth, the state’s Medicaid program, held an open meeting on May 24 about One Care, the state’s dual eligible demonstration project. Among the items discussed were detailed updates on quality performance and finances of the two participating health pans. The state also announced that the Commonwealth Care Alliance, one of two health plans serving dual eligibles enrolled in One Care, is now accepting new One Care enrollees in all covered counties.

New York

The New York State Department of Health issued a Request for Applications (RFA) announcing a funding opportunity for community based organizations (CBOs) to participate in Delivery System Reform Incentive Payment program (DSRIP) activities in underserved areas of the state. This RFA reflects the state’s concern that smaller CBOs face challenges in their ability to engage and contract with the lead organizations running the Performing Provider Systems (PPS) in DSRIP. These organizations tend to be administratively lean, have fewer resources and also compete with other CBOs for similar funding grants. Thus, the RFA seeks applicants from consortiums of CBOs whose members provide key services that directly impact the social determinants of health. Overall, these grants are intended to help CBOs better position themselves for continuing engagement with PPS in DSRIP projects and consequently in value-based payment and contracting. The state intends to make one award for each of the three regions: (1) New York City, (2) Long Island and Mid-Hudson and (3) Rest of State. A maximum funding amount for each region is $2.5 million. Applications are due by Aug. 16. To view the RFA, go to the NYS Grants Gateway and search by the opportunity name “Community Based Organization (CBO) Planning Grant.”

In other news, the Conference of Local Mental Hygiene Directors (CLMHD), in concert with New York state, has developed a plan to address and monitor behavioral health in the transition to Medicaid managed care through Regional Planning Consortiums (RPCs). CLMHD envisions the RPCs as a place where collaboration, problem solving and system improvements for the integration of mental health, addiction treatment services and physical health care can occur in a way that is data-informed, person- and family-centered, cost-efficient and results in improved overall health for adults and children in their communities. New York is preparing to expand the carve-in of behavioral health services in counties outside of New York City and Health and Recovery Plans (HARPs) will begin enrollment of eligible recipients with Serious Mental Illness (SMI) and Substance Use Disorders (SUD), effective July 1. Beginning Oct. 1, HARPs located outside New York City will offer members access to enhanced behavioral health home and community-based services.


The Centers for Medicare and Medicaid Services, the state of Ohio and participating Medicare-Medicaid plans executed an updated three-way contract for the MyCare Ohio dual eligible demonstration project. The updated contract extends the demonstration two additional years through Dec. 31, 2019.

In other news, On May 9 and 10, UHCAN Ohio staff met with three groups of dually eligible enrollees in Cleveland, Youngstown and Akron to present a workshop preparing them to serve on Consumer Advisory Councils. .CareSource and other Managed Care Organizations are forming Consumer Advisory Councils to get feedback from consumers who are enrolled in MyCare Ohio. Consumers who participate in the councils are representing themselves and other MyCare Ohio consumers to make sure they are getting the care they need.


The Pennsylvania Department of Human Services (DHS) released a five-year strategy to address several significant housing problems. The department will pursue four strategies: expand access and create new, affordable, integrated and supportive housing opportunities; strengthen and expand housing-related services and supports; assess new and existing programs to determine future needs and measure outcomes and promote teamwork and community in both state and local government to develop housing opportunities for all populations served by DHS. In the coming weeks, the Pennsylvania Health Access Network (PHAN) and their partners will officially launch their Housing as Healthcare Campaign.

In other news, in response to the Medicaid managed care final rule published by CMS last month, PHAN outlined three important issues they will be working on to enhance potential benefits for consumers: network adequacy; quality measurement and improvement; and plan information and enrollment counseling.

South Carolina

The state released the April/May 2016 stakeholder update for Healthy Connection Prime, South Carolina’s dual eligible demonstration project. Among the updates were enrollment figures for May 2016 as well as a map depicting the demonstration’s passive enrollment, including that to begin in July 2016. In related news, CMS issued a release to Healthy Connection Prime providers clarifying the prohibition against balance billing enrollees for any covered service.


The Centers for Medicare and Medicaid Services, the Commonwealth of Virginia and participating Medicare-Medicaid plans executed an updated three-way contract for the Commonwealth Coordinated Care (CCC) dual eligible demonstration project. The state plans on phasing out the CCC demonstration by end of 2017 and implementing its Medicaid Managed Long-Term Services and Supports (MLTSS) program by that time.